To establish the healing period of abrasions. Stages and timing of tattoo healing Fast healing without scars

The human body is very fragile, and it is susceptible to almost any mechanical influence. It is easy to cause a wound or any other injury. The same can be said about animals. For example, you can cut yourself very simply - with one awkward movement of the hand, but the wound will take a long time to heal. In several stages. The topic is very detailed, so it is worth talking about it and paying special attention to the types of wound healing.

Definition

It's worth starting with terminology. A wound is a mechanical damage to the integrity of the skin, mucous membranes, internal organs and deep-lying tissues. In medical terms, the clinical picture of this type of injury is determined by local and general symptoms. The first of these include pain, bleeding and gaping. Common signs include infection, shock and severe anemia. They are expressed to varying degrees - it all depends on the general condition of the person and the reactivity of the body.

So, the sharper the tool that cut the tissue, the more the wound will bleed. However, it is worth knowing about one nuance. Bleeding is not always external. Often it is internal. That is, blood pours into the cavities and tissues. Because of this, widespread hematomas are formed.

The pain, in turn, can be intense to varying degrees. Its strength depends on how many receptors and nerve trunks have been damaged. And also on the speed of injury. And how pronounced the pain is depends on the affected area. The face, hands, perineum and genitals are the most sensitive places on the human body.

In principle, this general information is enough to gain insight into the topic. Now we can talk about the types and classification of damage.

Classification

If we talk about the nature of tissue damage, we can distinguish gunshot, stab, cut, chopped, bruised, crushed, torn, bitten, poisoned, mixed wounds, as well as abrasions and scratches. Each of them has its own characteristics. And it depends on them what kind of wound healing will be. Types of wound healing also differ depending on the type of injury.

Gunshot wounds and stab wounds, for example, hardly bleed. It is also difficult to determine their direction and depth by eye. A special form of puncture wounds are those caused by a blow from a hairpin, a spear, the point of an umbrella, or a sharpened stick. Cut and chopped wounds are characterized by profuse bleeding and surface defects. Those bitten often produce pus afterwards. Although abrasions are painful, they heal the fastest.

In general, the classification is very detailed; it would take a long time to list all the types. But one more nuance is worth noting. The fact is that wounds are divided into late and fresh. The first are those with which a person consulted a doctor a day after receiving an injury. These are more difficult to cure, since infection and other microorganisms have already penetrated inside. A wound is considered fresh within the next 24 hours after application. Its consequences are easier to prevent.

Specifics of tissue restoration

Healing is a complex regenerative process that reflects a physiological as well as a biological response to injury. It is important to know that tissues have different healing abilities. The higher their differentiation (i.e., the slower new cells are formed), the longer they will regenerate. It is well known that the cells of the central nervous system are the hardest to recover. But in tendons, bones, smooth muscles and epithelium, this process occurs quite quickly.

When talking about the types of wound healing, it must be said that they heal faster if the nerves and large blood vessels remain intact. The process will last a long time when foreign bodies and virulent microorganisms (infection) enter them. Wounds still heal poorly in people suffering from chronic inflammatory diseases, diabetes mellitus and heart and kidney failure.

Primary healing

We need to talk about it first. After all, types of wound healing begin with the primary. Next comes the secondary. The last type is healing under a scab.

It tightens when its edges are smooth, touch as closely as possible and are viable. Healing will occur successfully if there are no hemorrhages or cavities inside, and there are no foreign bodies. Therefore, it is important to wash the wound. This also helps neutralize infections.

This type of healing is observed after aseptic operations and full surgical treatment of the injury. This stage passes quickly - in about 5-8 days.

Secondary healing

It can be observed when one of the conditions for the primary one is missing. For example, if the edges of the fabric are not viable. Or they don’t fit closely together. Cachexia and a lack of necessary substances in the body can contribute to secondary healing. And this type of tissue restoration is accompanied by suppuration and the appearance of granulations. What it is? Such newly formed glomeruli of blood vessels are called granulation. In fact, this is familiar to every person since childhood, because each of us fell and tore our knees. Everyone remembers that the wounds were then covered with a crust. This is granulation tissue.

In general, types of wound healing and their characteristics are a very interesting topic. Not everyone knows that the tissue repair process occurs in three stages. First, the inflammatory phase of healing takes place (about 7 days), then the granulation phase (7-28 days). The last stage is epithelization. That is, the wound is covered with new, living skin.

What do you need to know?

During the process of tissue repair, different types of wound healing take place. Apart from the inflammatory phase, they all last quite a long time. Although this depends on the depth of the damage. But the longest stage is the formation of the epithelium. May last for about a year.

The most important phase is the notorious granulation. It is this that promotes normal healing of the wound. Granulation tissue protects other, deeper ones, preventing the penetration of infection. If it is damaged, bleeding will begin. And the healing process will begin again. Therefore, it is very important not to touch the injury and protect it from direct contact with clothing and, in general, with any other objects/things.

Interestingly, the types of wound healing in animals are no different from us. But the process is more difficult for them. Animals try to heal their wounds themselves - they constantly lick, which can cause harm. This is why cats are put on a bandage or cone after sterilization - they cannot reach the wound and lick it to an even worse state.

Healing under the scab and treatment

This is the last type of tissue repair. Healing under the scab occurs if the damage is minor. When a person has an abrasion, for example, or abrasion. It’s just that for some time after the formation of the injury, a dense crust appears (the same scab), and a new epidermis quickly forms under it. The scab then falls off on its own.

Naturally, all wounds need to be treated. And how this should be done, the doctor explains. Self-medication will not help, especially in the case of open wounds. Because in this situation it is necessary to act step by step. The first phase of treatment is treatment with medical solutions that neutralize the infection. The second is preventing inflammation and swelling. For this purpose, tablets, sprays, ointments and gels may be prescribed. At the third stage, a person must, following medical recommendations, take care of granulation tissue, promoting its transformation into connective tissue.

Scars

The medical classification knows more than one type of scar. When a wound heals by primary intention, any scar can actually form. It doesn't all depend on how the fabrics are tightened. The type of scar is determined by the prerequisites for the appearance of the wound itself. Let's say a surgical operation. The man transferred it, and the cut made with a scalpel was stitched up. This is primary healing, since the tissues are in close contact and there are no infections. But it will still be called a surgical scar.

Another situation. A man was cutting tomatoes with a sharp knife and accidentally hit his finger with the blade. A domestic accident, one might say. But the type of healing is still the same, primary. However, it will be called an accident scar.

There are also keloid, normotrophic, atrophic and However, they are not related to the topic. It is enough just to know about these types of scars.

Causes of impaired wound healing

Finally, it’s worth saying a few words about why tissues sometimes recover so slowly. The first reason is the person himself. But violations appear even without his participation. You should consult a doctor if there is a change in pus, or if the severity of the wound increases. This is not normal and an infection is possible. By the way, to prevent it from appearing, it is important to constantly wash the wound.

You also need to know that the skin of an adult heals more slowly than that of teenagers, for example. Also, in order for the wound to heal faster, it is necessary to maintain a normal level of moisture in the tissues. Dry skin does not heal well.

But if the wound is serious and any abnormalities are observed, you need to consult a doctor and not self-medicate.

Material from the Forensic Encyclopedia

Abrasion- this is a superficial mechanical damage to the skin, not deeper than the papillary layer. Occurs as a result of the tangential impact of blunt or sharp (scratches) objects.

Abrasions- this is damage to certain layers of the epidermis or epithelium of the mucous membranes; in some cases, the papillary layer of the dermis is also damaged. (source?)

Depending on the depth, abrasions are divided into:

• superficial - damage only to the epidermis;
• deep - damage to all layers of the epidermis and upper layers of the dermis.

Age of abrasions

The average healing time is from 10 to 14 days. However, the healing time of abrasions can vary greatly depending on the depth of the damage and its size, location (intensity of blood supply to areas of the body), age, state of the immune system, and concomitant injuries.

Kryukov V.N. et al. (2001)

"... Upon external examination in the first hours after the formation of an abrasion, its bottom is sunken, the surface is pink-red, moist due to the constant secretion of lymph. In cases where the papillary layer is damaged, droplets of blood are mixed with the lymph.

After 6 hours, the bottom of the abrasion, as a rule, dries out, and a zone of hyperemia up to 1.0 cm wide is formed around it. At the same time, swelling (edema) increases and pain is noted. This process continues until the end of the first day. A yellowish-brown crust forms at the bottom. In deep abrasions with damage to the papillae, the crust is reddish-brown in color. The forming crust plays a protective biological role, protecting the damaged surface from contamination and infection.

Developing edema and cellular infiltration raise the crust, which by the end of the day is located at the level of the surrounding skin. At the end of the first day and at the beginning of the second, the crust becomes higher than the level of undamaged skin due to the development of the proliferative process - restoration of the damaged epidermis.

By this time the crust itself acquires a permanent dark brown color.

Since the regeneration processes of the epidermis are more pronounced in the peripheral areas where it is damaged, usually less deeply, on the 3-5th day peripheral peeling of the crust is observed... which ends by the 7-10th day.

In place of the fallen off crust, a pink surface remains, disappearing by the end of the second week..."

Belikov V.K., Mazurenko M.D. (1990)

Duration of abrasion	Abrasion
	MACRO - the surface is sunken, wet, red. MICRO - expansion of capillaries, small arteries and veins, increase in the number of leukocytes with their parietal location, edema.
	MACRO - the surface is sunken, red, drying out. MICRO - perivascular accumulation of predominantly segmented leukocytes, leukocyte infiltration in the peripheral parts of the injury.
	MACRO - the surface is sunken, brown-red, dried out. MICRO - leukocyte infiltration is well expressed not only along the periphery, but also in the area of ​​damage, individual leukocytes.
	MACRO – the surface at the skin level is dry, red-brown. MICRO - a pronounced leukocyte shaft at the border of the damage, collagen damage and changes in nerve fibers are detected.
	MACRO - a dense red-brown crust above the skin level. MICRO - lymphoid infiltrates, proliferation of cells of the germ layer of the epidermis.
	MACRO - a dense, brown crust that falls off above the level. MICRO – macrophage reaction with the appearance of fibroblasts, proliferation of germ layer cells in the form of epithelial strands.
	MACRO - dense, brown peeling crust. MICRO - the epidermal defect is replaced by several layers of epithelial cells.
10-15 days	MACRO - the spot at the site of the abrasion is even, smooth, pink or bluish. MICRO - the epidermis at the site of the former defect has a normal appearance.

Akopov V.I. (1978)

"...the formation of a crust, on average, occurs 4-6 hours after the occurrence of an abrasion. The newly formed crust is delicate, pale pink in color, located below the level of the surrounding skin. By the end of 1 day, a clearly formed dense red crust is formed, falling off after 7-12 days. However, we found the mark remaining after it fell off a month or more after receiving the abrasion..."

Kulik A.F. (1975)

"...on the neck the crust disappears after 5-6 days, on the upper extremities - after 8-9, on the lower extremities - after 9-11, on the stomach - after 10-13 days."

Kulik A.F. (1985)

Stages of healing of abrasions of various ages and locations

№ p/p	Stages of healing of abrasions	Localization of abrasions
		Neck	Back	Upper limbs	Lower limbs	Stomach
1	The crust is located at the level of intact skin	After 12 hours	By the end of the first day	By the end of the first - beginning of the second day	By the end of the second day	By the beginning of the third day
2	The crust rises above the level of intact skin	By the end of the first day	On the second day	By the beginning of the third day	Third - fourth days	Fourth day
3	The crust peels off along the periphery of the abrasion	Fourth day	Fifth day	On the sixth day and noticeable only under a magnifying glass	Seventh - eighth days	End of the eighth day
4	Parts of the crust fall off	By the end of the fifth day	Sixth day	By the end of the eighth day	Ninth day	Tenth day
5	The crust disappears completely	Sixth day	Eighth day	Ninth day	Tenth - eleventh day	Twelfth day
6	Abrasion marks disappear	After 12-13 days	After 12-15 days	After 14-15 days	After 17-18 days	After 18-20 days

Mukhanov A.I. (1974)

The surface of a fresh abrasion is pink-red, moist, soft, painful...

After 6-12 hours, the bottom of the abrasion dries out; Around the abrasion, redness and swelling appear in the form of a ring up to 0.5 cm wide. By 24-36 hours, the surface of the abrasion thickens, the swelling and pain disappear.

As M.I. Raisky notes, in the majority of abrasions (up to 70%), by 24 hours the bottom is covered with a brownish dense crust located above the skin level. The surface of the remaining abrasions is sometimes wet and soft, more often dried, dense, brownish, located at the level of the skin (up to 8%) or below it (up to 21%). According to the observations of V.I. Akopova (1967), by the end of the first day, all abrasions have a crust. On the second day, the surface of the abrasions rises above the intact skin due to thickening of the crust...

On the 3-4th day (according to V.I. Kononenko, more often on the 5th day), the crust along the edge begins to peel off and the abrasion is reduced by half. Then peeling of the skin around the abrasion appears, the crust peels off over a large area and disappears after 1-2 weeks.

The surface at the site of the fallen off crust is pink at first, but within a week this color disappears, and the abrasion site ceases to differ from the surrounding skin. Healing of abrasions ends in 2-3 weeks...

Abrasions heal faster in healthy people, slower in sick people and in victims with severe injuries.

Kononenko V.I. (1959)

Signs detected during the healing process	Time from the moment of abrasion formation
The surface of the abrasion is mainly pink-red in color, moist, below the level of the surrounding skin, whitening is observed around it	1 hour
The surface dries out, redness and swelling around the abrasion is about 0.5 cm wide	6-12 hours
The surface becomes denser, the swelling disappears. There is a disappearance of the sometimes existing pain	24-36"
The surface is often brownish-red in color, dense to the touch, mainly at the level of intact skin. The influence of the infectious onset is reduced	2 days
The abrasion is almost always covered with a crust that rises above the skin level. Dark, brown, yellowish shades predominate. Noticeable wrinkling and reduction in size	3"
The crust usually rises above the skin level	4 "
A crust with undermined edges, its color is often red-brown, the size of the abrasion is halved	5 days
The same phenomena are expressed more sharply; peeling of the skin is observed around the abrasion	6-7"
Reducing the initial size of the abrasion by 4 times	8 "
The crust falls off (its rejection is possible earlier), a pale pink area remains at the site of the fall off	9-11"
Reduction in the size of the indicated area, its color is dominated by pinkish-reddish shades	15-16 days or more
Gradual, traceless disappearance of the specified area	20-30 days

"...24 abrasions were observed in people aged from 11 to 56 years (mainly 11, 25, 30 and 56 years old). On the first day, observation was carried out 4 times, on the second and third - 2 times, on the rest - once every 24 hours. The localization of abrasions was different: lower leg, thigh, forearms, hands, neck and chest..."

Taikov A.F. (1952)

(quoted from Mukhanov A.I.)

Healing time for abrasions in days (source unknown)

Employees of the Department of Forensic Medicine of the Kyiv Institute for Advanced Medical Studies summarized the data of various authors on the healing time of abrasions depending on their location and proposed the following table:

Sign	Localization
	face		hands		legs
	surface	deep	surface	deep	surface	deep
Abrasion without crust	1	1	1	1	1	1
Does not rise above the surface	1-2	1-3	1-2	1-3	1-2	1-5
Rising above the surface	2-5	2-8	2-6	2-10	2-7	2-12
The edges of the crust are raised	5-6	6-9	6-8	6-15	5-8	6-15
Partially disappeared	6-8	7-15	7-12	11-18	7-12	11-12
Has disappeared completely	7-11	12-18	9-13	16-23	8-13	15-24
Traces of abrasion	up to 30	up to 30	up to 50	up to 50	up to 120-150	up to 150

Source unknown. If you know, write on the forum

No sources indicated

A.P. Gromov distinguishes between superficial and deep abrasions. In a superficial abrasion, the upper and partially middle layers of the epidermis or completely the upper, middle and partially germinal (basal) layers are absent; the latter is usually stored in the recess between the papillae of the skin itself. There is an accumulation of lymph on the surface of the superficial abrasion. The latter mixes with particles of the destroyed epidermis and foreign inclusions and quickly dries, forming a thin pink crust.

In a deep abrasion, either the entire epidermis with the apexes of the papillae or the upper layers of the dermis are missing. In such cases, there is a massive accumulation of fluid and lymph on the surface of the abrasion. Mixing with the remains of the destroyed epidermis and foreign particles, the blood coagulates, forming first a wet and then a drying red crust.

According to Akopov V.I. By the end of the first day after their occurrence, all abrasions are covered with crusts; on the second day, the surface of the abrasions rises above the intact skin.

A.F. Taikov distinguishes four stages in the healing of an abrasion:

• 1st - minus fabric; lasts for several hours;
• 2nd - crust formation; begins in a few minutes and lasts up to 4 hours (sometimes 2-4 days);
• 3rd - epithelization and crust falling off; lasts from 5 to 7-9 days;
• 4th - traces remaining after the crust falls off; are detected within 9-12 days, sometimes persisting up to 25 days.

According to Naumenko V.G. and Grekhov V.V. the crust disappears within 7-12 days, abrasion marks disappear within 10-12 days. Rubin V.M. and Krat A.I. observed the crust falling off from superficial abrasions on days 7-12, deep abrasions on days 12-21, traces of abrasions can be distinguished even after 1.2-1.5 months.

The main task in the postoperative period is to prevent the development of infection and speed up the regeneration process in all possible ways.

Stages of suture healing

After abdominal surgery and suturing, the healing process includes several stages

1. Formation of collagen or connective tissue by fibroblasts. During the healing process, fibroblasts are activated by macrophages. Fibroblasts migrate to the site of damage, and subsequently they bind to fibrillar structures through fibronectin. At the same time, the process of active synthesis of extracellular matrix substances begins, among which collagen is present. The main task of collagen is to eliminate tissue defects and ensure the strength of the emerging scar.
2. Epithelization of the wound. This process begins as epithelial cells migrate from the edges of the wound to its surface. After epithelization is complete, a kind of barrier to microorganisms is formed, and fresh wounds are characterized by low resistance to infections. A few days after the operation, in the absence of any complications, the wound regains its resistance to infection. If this does not happen, then perhaps the cause was a suture dehiscence after surgery.
3. Reduction of wound surfaces and wound closure. This result can be achieved due to the effect of wound contraction, which is to a certain extent caused by the contraction of myofibroblasts.

The healing period after surgery is largely determined by the characteristics of the human body. In some situations, this process occurs quite quickly, while in other patients it can take quite a long time.

Treatment of sutures after surgery

Before answering the question of how long it takes for a suture to heal after abdominal surgery, you need to understand what affects this process. One of the conditions for a successful result is the implementation of correct therapy after the patient is sutured. In addition, the following factors influence the duration of the postoperative period:

• sterility;
• materials for processing seams;
• regularity of the procedure.

After surgery, maintaining sterility is considered one of the important requirements. This means that seam treatment is only allowed with well-washed hands using disinfected instruments.

How are sutures treated after abdominal surgery, and what disinfectants are the most effective? In fact, the choice of a particular drug is determined by the nature of the injury, and for treatment you can use:

• medical alcohol;
• hydrogen peroxide;
• potassium permanganate solution;
• brilliant green;
• ointments and gels with anti-inflammatory effects.

If it is necessary to treat postoperative sutures at home, then for this purpose you can use the following traditional medicine:

• pure tea tree oil;
• tincture of larkspur roots from 20 grams of herbal remedy, 200 ml of water and 1 glass of alcohol;
• cream with calendula extract, to which you can add a drop of orange or rosemary oil.

Before using such folk remedies at home, it is recommended to first consult with a specialist.

What affects healing?

The duration of wound healing after suturing depends on the following factors:

• the age of the patient - in young people tissue restoration occurs much faster than in older people;
• body weight - the wound healing process can slow down if a person is overweight or obese;
• nutritional features - lack of energy and plastic material can affect the quality and speed of reparative processes in the wound;
• dehydration - a lack of fluid in the body can lead to an electrolyte imbalance, which slows down the healing of sutures after surgery;
• state of blood supply - wound healing occurs much faster if there are a large number of vessels near it;
• chronic pathologies can slow down the recovery process and cause various complications;
• state of immunity - with a decrease in the body's defenses, the prognosis of surgical intervention worsens and wounds may fester.

The supply of the required amount of oxygen to the wound is considered one of the main conditions for wound healing, since it participates in the synthesis of collagen and helps phagocytes destroy bacteria. Anti-inflammatory drugs can slow down the healing process in the first few days, but subsequently have virtually no effect on this process.

One of the common reasons for the deterioration of a wound after surgery and a slowdown in its healing process is considered to be secondary infection, which is accompanied by the formation of purulent exudate.

Processing rules

In order for the healing of sutures to take place as quickly as possible without the development of complications, it is necessary to adhere to the following rules:

• before starting the procedure, it is necessary to disinfect hands and instruments that may be needed to carry it out;
• You should carefully remove the applied bandage, and if it is stuck to the skin, pour peroxide on it;
• you need to smear the seam with an antiseptic using a cotton swab or gauze swab;
• the bandage must be carefully applied.

It is important to remember that seams should be treated twice a day, but if necessary, the amount can be increased. In addition, it is necessary to carefully examine the wound each time for the presence of any inflammation. It is not recommended to remove dry crusts and scabs from the wound, as this can lead to the appearance of scars on the skin. You should shower with care and do not rub the seam with a sponge that is too hard. If the sutures on the abdomen turn red or purulent exudate begins to ooze from them, you should see a doctor as soon as possible.

Only a doctor can decide when sutures are removed after abdominal surgery. This procedure is carried out under sterile conditions using special instruments and usually 5-10 days after surgery.

Healing products

In order to speed up the resorption and healing of sutures after surgery, you can use antiseptics at home. Experts recommend using them not to treat wet wounds, but only when the healing process has begun. The choice of one or another ointment depends on the nature of the damage and its depth. For shallow superficial wounds, the use of simple antiseptics is recommended, and if complications develop, it is necessary to use drugs containing hormonal components.

How to remove a scar after abdominal surgery, and what ointments are considered the most effective for treating sutures?

• Vishnevsky ointment accelerates the removal of pus from the wound;
• Levomekol has a combined effect;
• Vulnuzan contains natural ingredients and is easy to use;
• Levosin destroys bacteria and stops the inflammatory process;
• Stellanin helps get rid of tissue swelling and destroy infections, and also accelerates skin regeneration;
• Argosulfan has a pronounced bactericidal effect and helps to achieve an analgesic effect;
• Actovegin successfully fights the inflammatory process in the wound;
• Solcoseryl minimizes the risk of scars and cicatrices.

Such medications, when used correctly, help speed up the healing process of the wound after surgery and avoid infection. It is important to remember that before smearing a postoperative suture on the abdomen, you must consult a doctor. The fact is that independent treatment of postoperative sutures can result in severe suppuration of the wound and its further inflammation. Compliance with simple rules is the key to successful treatment of postoperative sutures and helps prevent the formation of scars.

How long do stitches take to heal?

Any surgical intervention that violates the integrity of the body’s skin ends with the application of postoperative sutures. Many factors influence how long it takes for sutures to heal and whether scar tissue forms in this area. Let's find out how long it takes for sutures to heal and what it depends on.

How long do stitches take to heal: approximate time frame

The postoperative wound heals 7-9 days after surgery. It is after this period of days that the sutures are removed if they were made with non-absorbable materials. At the same time, for surgery on a certain area of ​​the body, the following average healing times can be distinguished:

• after laparoscopy or removal of appendicitis, the sutures heal within 6-7 days;
• after extensive abdominal surgery, wound healing may take up to 12 days;
• Wounds take a long time to heal even after operations in the sternum - up to 14 days;
• sutures from meniscus surgery can be removed on the 5th day;
• head wounds heal on the 6th day;
• post-amputation wounds heal on the 12th day.

However, it is worth keeping in mind that the connective tissue, which is responsible for the strength of wound healing, grows in 2-3 months.

Influencing factors

In the absence of any complications after surgery, concomitant pathologies and complicating factors described below, postoperative sutures are quickly tightened. How long do stitches take to heal? The patient can be discharged home within 5-7 days after surgery. For approximately 6 months after surgery, he is still not allowed to lift weights or do heavy work. Let's take a closer look at what determines the speed of healing of sutures.

• Patient's age: the younger the person, the faster the processes of tissue fusion and scar formation occur.
• The patient's weight and the presence of subcutaneous fat deposits affect the healing process of sutures. In people suffering from obesity, healing of postoperative sutures takes longer and usually with complications.
• The patient’s diet has an impact - after all, the more varied a person eats after surgery, the faster the wounds heal.
• Water depletion of the body (dehydration) provokes the appearance of an imbalance of electrolytes. This leads to disturbances in the functioning of the kidneys and heart. The tissues are not saturated with oxygen in sufficient quantities, and as a result, the healing process is inhibited.
• The speed of healing of sutures also depends on the type of blood supply in the surgical area. Therefore, for example, wounds on the face heal faster.
• The state of the patient's immunity directly affects the rate of wound healing. In patients with HIV status or immunodeficiency, the healing process is sometimes very delayed, so they need to treat the postoperative wound much more often.
• One of the factors is the presence of chronic or endocrine diseases. For example, diabetes mellitus greatly complicates the healing of sutures.
• The healing of sutures is affected by pathogenic organisms or suppuration in the wound. The healing process of sutures is also slowed down due to secondary infection of postoperative wounds.
• The healing time clearly depends on the size of the wound. The larger its area, the longer the healing process takes place.

Suture material and suturing methods

Seams can be made with natural or synthetic threads. In recent years, self-absorbable suture materials are increasingly being used, since the healing of such wounds is much easier and faster. In addition, such sutures do not need to be removed, and this greatly facilitates the recovery process after surgery, because the patient does not suffer from unnecessary discomfort during the removal of the threads. Such threads that can be absorbed can be of either natural origin (for example, bovine veins) or synthetic (multifilament: polysorb, vicryl; monofilament: polydioxanone, catgut, maxon, etc.).

Non-absorbable suture materials (silk, nylon, prolene, etc.) require removal from the wound after its edges have fused. But the fact that such threads are in the wound while it is healing increases the possibility of infection. In addition, during their removal, the wound surface is again slightly damaged, which complicates the healing of the sutures. You can find out more precisely when such sutures are removed from our article: How long after sutures are removed.

How long it takes for sutures to heal depends on how they were applied. Thus, single-row sutures (the simplest, superficial ones) heal and can be removed after 3-5 days. And multi-row ones, when several layers of tissue are sewn together at once, heal longer and more difficult, moreover, there is a high probability of their suppuration. Therefore, such sutures are removed no earlier than after 7-10 days.

Stitches after childbirth

How long the sutures heal after childbirth, if they were natural, depends on how many ruptures occurred during childbirth. So, stitches can be placed on the cervix. They are performed with absorbable threads. These stitches do not require special care; you just need to give up sex for 1-2 months. But sutures on the vagina and perineum take longer and are more difficult to heal. It is impossible to apply any bandages to this area, so the seams here constantly get wet and stretch when moving, which makes it even more difficult for them to heal. Therefore, it is necessary to treat them as often as possible with antiseptics. The healing time for deep tears can take up to 3 months.

A suture from a caesarean section wound is made on the uterus and on the surrounding skin. At the same time, the suture on the uterus, made with absorbable threads, heals quite quickly and painlessly. However, it scars only two years after the operation, so doctors do not recommend planning a pregnancy before this period. But the seam on the skin is usually quite large and causes pain during healing. Such sutures are applied with non-absorbable materials, which will need to be removed after a week, or with absorbable materials, which will completely dissolve within two months.

How many days does it take for a stitch to heal after surgery?

After any operation followed by sutures, patients ask: “How long does it take for a suture to heal after surgery?” And any doctor will say that, although there are certain deadlines, this process takes place individually for each person. In short, in one patient the suture heals faster, while in another it takes longer.

In addition, there are certain factors that influence this process.

1. Patient's age. At a young age, all processes in the body go faster, the recovery rate is higher, and the healing of sutures is faster than in older people.
2. Body mass. If a person is obese, then healing sutures is a more difficult process for him, since adipose tissue has a poor blood supply and is more susceptible to injury and infection.
3. Nutrition. Nutritional culture greatly influences the restoration of damaged tissue. After surgery, a person needs protein foods and a diet rich in vitamins. If nutrition does not meet the body's needs, the sutures take much longer to heal.
4. Lack of water. With a lack of water in organs and tissues, the load on internal organs, such as the kidneys and heart, increases, and metabolism also slows down. As a result, the surgical area takes much longer to heal.
5. Blood supply to the damaged area. The suture site is in greater need of good blood supply. Thanks to this, the healing of the suture will be faster.
6. Immune status. If the immune system is not strong enough, if a person is infected with the immunodeficiency virus, recovery after surgery will be much more difficult and slower. This category also includes people undergoing chemotherapy. A characteristic complication for them is wound suppuration.
7. Chronic diseases. These include diseases such as diabetes. They increase the development of complications and slow down the healing process.
8. Sufficient amount of oxygen. Lack of oxygen in tissues and cells negatively affects wound healing, collagen synthesis and phagocytosis, the process of ingesting bacteria, are reduced. Along with oxygen, other nutrients are supplied; their deficiency slows down the recovery and formation of new tissues.
9. Recurrence of infection. This reason quite often spoils the recovery picture.

Healing time for sutures

The answer to the question of how many days it will take for the suture to heal after surgery is ambiguous. This is an individual process and depends on many factors. Basically, the wound heals after surgery within 9 days. After this, the sutures are removed if they were applied with non-absorbable materials. But in different parts of the body, sutures heal differently. Here are the approximate healing times:

• removal of appendicitis and laparoscopy days;
• extensive abdominal operations - up to 12 days;
• surgery in the sternum - up to 14 days;
• surgery on the meniscus - up to 5 days;
• in the head area - up to 6 days;
• wounds after amputations - up to 12 days.

Ways to speed up the recovery process

How long it takes for sutures to heal largely depends on the patient. In order to speed up this process, you need to follow several rules. If we consider in general, all these measures are aimed at strengthening the immune system and preventing complications:

1. Physical activity within reasonable limits. On the one hand, during exercise, blood circulation improves, more oxygen and nutrients reach the wound site, which has a beneficial effect on the sutures. But on the other hand, you need to be careful and prevent the seam from coming apart.
2. Diet after surgery. Nutrition should be aimed at replenishing the required amount of proteins for the construction of new tissues and preventing disruption of intestinal function. In addition, among the negative effects of taking antibiotics and many other medications, digestive upset is observed.
3. Use of traditional local remedies. These include ointments and balms aimed at tissue regeneration.
4. Additional intake of drugs that enhance immunity. These include various vitamins, supplements, enzymes and anti-inflammatory drugs.
5. Phytotherapy. The use of decoctions orally or the procedure of wiping and treating stitches with collections of medicinal herbs.

The last point can be separated into a separate category. The use of herbal infusions in postoperative care for sutures can speed up recovery. Herbal medicine has long been identified as a separate technique, but is still used mainly with traditional treatment. This therapy is prescribed by doctors and its beneficial effects are recognized.

Often this treatment is used directly to speed up the healing of wounds and sutures.

In order to use herbal remedies, you need to consult a doctor. He will select the most suitable option. These can be teas and decoctions for oral administration, which increase immunity and body tone, or decoctions for local treatment of sutures. Such drugs have an anti-inflammatory effect, relieve pain, improve the circulation of substances, have an antimicrobial effect, and improve the formation of new tissue at the wound site.

Possible complications that slow down the healing of sutures

After suturing, complications with its healing may arise for various reasons. As a rule, this is an infection, due to which suppuration of the suture develops, preventing its healing. There may be several reasons for infection:

• poorly processed materials during surgery;
• the appearance of hematoma and the development of tissue necrosis;
• poor quality of materials used for suture;
• weak immunity and general health.

These reasons significantly complicate the patient’s recovery. If the surgeon’s work was not sufficiently qualified, and complications arose after the operation, then in this case it remains to deal with the consequences. But you can try to eliminate the cause of weakened immunity in advance. You just need to eat right, take vitamins and exercise. Such active people have much greater body reserves, and at critical moments they will cope with inflammation and illness. In addition, their internal reactions proceed faster, and these include the processes of recovery, metabolism, oxygen transportation and the formation of new tissues. Therefore, people who lead an active lifestyle usually recover faster and tolerate various diseases more easily.

Proper seam processing is required

By maintaining hygiene in relation to the postoperative suture, you can avoid unpleasant complications and speed up the healing process. Sutures after surgery must be carefully looked after. If a complication develops, such sutures take much longer to heal. To avoid complications and reduce recovery time, the seams must be processed correctly. It is necessary to stock up at the pharmacy with hydrogen peroxide, brilliant green, cotton swabs and disks, and sterile bandages. You should definitely consult your doctor about how often you need to treat the seam. Before handling, you need to wash your hands with soap and dry them well. Seams should be treated after water procedures.

Initially, blot the treated area with a towel. Do not rub under any circumstances; you need to blot very carefully so as not to tear off the resulting crust. After this, give the skin a little time to dry, and then treat it with hydrogen peroxide. This can be done in two ways: blot the seam with a soaked bandage or water it with a thin stream. After processing, let it dry again. Using a cotton swab, apply brilliant green and, if necessary, apply a bandage. Usually no bandages are required, but in some cases your doctor may recommend using a bandage to care for your stitches. If you carry out this treatment at least once a day, you will soon see that the stitches heal faster.

If you follow all the doctor’s recommendations and exclude harmful factors, in the presence of which the sutures heal worse, you can significantly reduce their healing time and minimize complications. The main thing is not to forget about proper nutrition, hygiene procedures and reasonable physical activity.

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How long does it take for a suture to heal after abdominal surgery?

Any surgical operation is caused by a violation of the integrity of the skin and is completed by suturing. There are many factors that influence the healing time of postoperative sutures and the formation of scar tissue at the surgical site. Let's figure out what the healing time of sutures is and what factors influence it.

Average healing time for surgical sutures

Postoperative wounds heal a week (+-2 days) after the operation. This is how much time passes after surgery before removing sutures made from non-self-absorbing materials. However, it should be noted that the healing time of the sutures depends on the part of the body where the integrity of the skin was damaged.

Average healing time depending on

from the operated area of ​​the body

Surgery to remove the appendix. The sutures are tightened on the sixth day after surgery

Laparoscopic surgery. Sutures heal on the seventh day

Extensive abdominal operations. The maximum healing period for sutures when applied correctly is 12 days.

Operations of the sternal region. The seams last quite a long time - up to two weeks.

Surgical interventions on the knees. Stitches are removed on the fifth day

Wounds after amputation usually heal on the 13th day

But you need to know that even after the stitches dissolve and heal, the wounds will heal with connective tissue only a couple of months after the operation.

When the sutures heal also depends on the method of their application. Seams can be multi-row or single-row. The first ones heal somewhat more difficult and, accordingly, take longer (from 7 to 10 days). And single-row ones can be painlessly removed five days after the operation.

Additional factors

We must not forget that the speed of healing of sutures after abdominal surgery also depends on the age of the patient. The younger he is, the faster and more successful both the rehabilitation period in general and the healing of sutures in particular will be. The amount of fat in the patient’s body also plays a significant role in the healing time of postoperative sutures. Simply put, if the patient’s weight significantly exceeds normal values, then the stitches will take longer than average, and suppuration is possible.

Doctors also say that after abdominal surgery, the patient should under no circumstances be allowed to become dehydrated. Otherwise, there is a high probability that the sutures will take too long to heal.

How to remove stitches after surgery

The doctor removes the sutures after the operation, but we will talk about what it is and how the process itself occurs. There are also threads that do not need to be removed; they dissolve on their own. This is a suture material such as catgut, vicryl and others. Catgut usually begins to dissolve within 7-10 days. Vicryl usually dissolves within a day, but there are situations when the wound heals much earlier and there is no need for threads, so it is better to remove them. If the wound has healed, but the threads are not removed, then a feeling of tension appears, which causes discomfort.

Cosmetic stitch after caesarean section

A caesarean section is an extensive abdominal operation, during which a sequential dissection of many different soft tissues occurs, which, after removing the child, must also be sequentially connected using suture material.

Inflamed suture after caesarean section

Since a cesarean section is an extensive abdominal operation with dissection of various soft tissues, the healing process of the surgical wound lasts about six weeks and requires careful attention to the area of ​​the postoperative suture. One of the complications that can develop after a cesarean section is inflammation of the postoperative suture.

How to treat a suture after a caesarean section

A caesarean section is an abdominal operation (laparotomy) in which the skin, subcutaneous tissue, muscles, peritoneum and uterus are cut to remove the baby. A caesarean section is performed if the risk of possible consequences during spontaneous childbirth exceeds the risk of surgery. It is performed strictly according to indications and can be planned or urgent (urgent).

Abdominal drainage for diseases

Drainage is the creation of free, unimpeded outflow of blood, wound secretions and pus from wounds by installing drainage and applying an appropriate bandage. As a result, conditions are created for the fastest cleansing of the wound and its healing.

For drainage, use: rubber tubes of various calibers, strips of gauze, rubber strips. Modern materials have appeared from which polyethylene and polyvinyl chloride tubes are made.

Upper median laparotomy

Upper median laparotomy is one of the options for surgical access to the abdominal organs during surgical interventions. Its essence lies in making an incision in the abdominal tissue (anterior abdominal wall) in the longitudinal direction along the midline. The peculiarity of the upper median laparotomy is that the dissection is made from the angle of the costal arches with the xiphoid process under the sternum to the navel.

After laparotomy: recovery period

Any medical intervention in the life of every person brings anxiety to one degree or another. It is especially difficult to survive an operation, even a small one. The operation itself and recovery after it require a lot of mental strength. Let's take a look at some of the features of recovery after laparotomy.

Laparotomy in gynecology

Laparotomy is a type of surgical treatment in which the surgeon gains open access to the abdominal cavity. Today, this is one of the main methods of surgical intervention used in gynecology.

Rehabilitation after abdominal surgery

Abdominal surgery is a surgical intervention in the chest or abdominal cavity with a violation of a specific protective barrier (pleura or peritoneum). Therefore, you should take the rehabilitation period seriously, give the body time to restore lost strength and the opportunity to cope with stress.

Abdominal surgery: removal of uterine fibroids

Surgery to remove uterine fibroids is quite relevant due to the large number of women diagnosed with fibroids. Increasingly, patients of gynecological clinics are interested in questions about indications and contraindications for this surgical intervention, about the average cost, methods of removal and the rehabilitation period.

Wound healing is a dynamic process consisting of three overlapping stages: inflammation, granulation tissue formation, and skin maturation or remodeling. The contribution of each of these stages to the healing process depends on the depth of the injury.

Shallow wounds. Shallow wounds involve the epidermis and upper layers of the dermis. Skin appendages (hair follicles, sweat and sebaceous glands) are preserved. Thrombosis, inflammation and formation of granulation tissue are slightly expressed. The healing of shallow wounds is based on epithelization due to the preserved skin appendages and marginal epidermis, which ultimately leads to complete and rapid restoration of the skin with invisible scars or without them at all. Hyper- or hypopigmentation may remain at the wound site.

Deep wounds. A necessary step in the healing of deep wounds is the formation of a blood clot to stop bleeding from relatively large vessels in the deep layers of the dermis. Inflammation and granulation tissue formation are important steps in healing, along with skin tension, which brings wound edges closer together to promote epithelialization. Since the skin appendages are damaged, epithelization of deep wounds occurs only due to the marginal epidermis and the lost tissue is replaced by scar tissue.

To understand the pathogenesis of scarring, it is necessary to know how wound healing occurs normally.

Stage of inflammation

The first thing that happens when a wound heals is the formation of a hematoma. This ensures the cessation of bleeding from damaged vessels and the creation of a barrier that prevents microorganisms from entering the wound. The thrombus is a temporary matrix into which inflammatory cells migrate. When platelets are destroyed, many growth factors are released, incl. transforming growth factor (TGF-β1), epidermal growth factor, insulin-like growth factor type 1 (IGF-1) and platelet-derived growth factor, which attract inflammatory cells, promote extracellular matrix synthesis and vascular sprouting.

A number of other signaling molecules, such as fibrinolysis products, attract neutrophils and monocytes to the wound. These cells come from the bloodstream by diapedesis through the endothelium of the capillaries adjacent to the wound. The main function of neutrophils is phagocytosis and destruction of microorganisms inside cells. In addition, neutrophils produce inflammatory mediators, under the influence of which keratinocytes and macrophages can be activated already at this stage of healing.

At the end of the acute inflammatory reaction (after 1-2 days), monocytes that migrated from the bloodstream become macrophages and destroy remaining microorganisms and dead cells. These macrophages also serve as a source of growth factors and inflammatory mediators, in particular platelet-derived growth factor, which attract fibroblasts to the site of injury.

Proliferation stage

Fresh granulation tissue is very rich in blood vessels and cells. Since epithelization alone is not enough to heal deep wounds, proliferation of fibroblasts in the areas of the dermis adjacent to the wound begins already in its first stages. Fibroblasts migrate into the wound, lining an extracellular matrix consisting of fibrin, fibronectin, vitronectin and glycosaminoglycans. Fresh granulation tissue has a high ratio of type III collagen to type I collagen.

In response to the action of growth factors in the wound, proliferation of keratinocytes and fibroblasts begins. As granulations form and excess collagen matrix appears, the number of cells decreases through apoptosis. What triggers apoptosis is unknown. Under the influence of substances that stimulate angiogenesis, which serve as inducers of endothelial growth factor, TGF-β1, angiotropin and thrombospondin, vessels begin to grow into the extracellular matrix.

Myofibroblasts help bring the edges of large wounds closer together, which reduces the amount of granulation tissue required to fill the wound cavity and reduces the area of ​​epithelialization. Due to the contractile proteins actin and desmin, fibroblasts also help bring the edges of the wound closer together. The mechanical tension that occurs after the edges of the wound are closed signals the cessation of tension.

Epithelization begins within a few hours after the wound appears. Migrating keratinocytes activate tissue plasminogen activator and urokinase and increase the number of urokinase receptors, which in turn promotes fibrinolysis, an important step necessary for keratinocyte migration. To pass through the temporary matrix formed by the thrombus, keratinocytes form additional fibronectin and collagen receptors. Migration of keratinocytes and epithelization is facilitated by the tension of the wound edges.

Stage of maturation and restructuring (complete healing)

At the restructuring stage, excess collagen and temporary matrix are removed by tissue enzymes, and inflammatory cells leave the wound. When the scar matures, a balance arises between the processes of destruction of the temporary matrix and collagen synthesis.

On the one hand, fibroblasts synthesize collagen, contractile proteins and extracellular matrix, on the other hand, fibroblasts, mast cells, endothelial cells and macrophages secrete a number of enzymes (matrix metalloproteinases) necessary for destruction and restructuring. The balance between these proteinases and their tissue inhibitors plays an important role in the repair of damaged tissues.

Interferons produced by T-lymphocytes (interferon-γ), leukocytes (interferon-α) and fibroblasts (interferon-β) prevent the development of fibrosis and suppress the synthesis of collagen and fibronectin by fibroblasts.

The restructuring process lasts from 6 to 12 months, but can last for years. The strength and elasticity of a scar is usually only 70-80% of that of intact skin, making scars more susceptible to repeated trauma.

Factors influencing wound healing and scar formation

Age. Unlike adults, wounds on fetal skin heal quickly and without scarring. The mechanism of scarless healing is unclear, but it is known that inflammation is mild, a large amount of hyaluronic acid is present in the wound contents, and collagen fibers are arranged in a certain order.

The fetal body is significantly different from the adult body. The main difference is in the characteristics of tissue oxygenation: the oxygen content in them remains relatively low throughout the entire period of intrauterine development. Inflammation in fetal wounds is mild due to neutropenia. As the fetal immune system develops, the inflammatory response becomes more pronounced and scars may form at the site of the wounds.

The fetal skin is constantly bathed in warm, sterile amniotic fluid, which contains many growth factors. But this alone does not explain scarless healing. In experiments on fetal lambs, isolating the wound from amniotic fluid using a silicone dressing did not prevent scarless healing; on the other hand, adult skin grafted onto the fetus healed with scar formation, despite contact with amniotic fluid.

The high content of hyaluronic acid in the extracellular matrix increases cell mobility, enhances their proliferation, and hence the restoration of the damaged area. This allows us to consider hyaluronic acid as the main factor in scar-free healing. A glycoprotein absent in adult wounds was found in fetal wounds. This glycoprotein stimulates the synthesis of hyaluronic acid. In addition, it is assumed that its long-term presence in fruit wounds promotes the orderly deposition of collagen during their healing. When treated with hyaluronic acid, the perforated tympanic membrane of rats not only recovered faster than in control animals, but there was also less scar tissue at the site of damage, and the collagen fibers were arranged in an orderly manner.

Rapid epithelization of wounds in the fetus may be due to the early accumulation of fibronectin and tenascin in the wound contents. Fetal and adult fibroblasts are different. Fetal fibroblasts at the beginning of fetal development produce more collagen types III and IV, while adult fibroblasts produce mainly type I collagen. In addition, fetal fibroblasts are capable of simultaneously proliferating and synthesizing collagen, while in the adult fibroblast proliferation precedes collagen synthesis. Thus, in adults, during wound healing, the appearance of collagen deposits is somewhat delayed, which leads to the formation of scars. Skin tension does not play a role in scarless healing, because Fetal wounds are virtually devoid of myofibroblasts.

Inflammation plays a key role in the restoration of damaged tissue and scar formation. In the fetus, in the absence of inflammation, wounds heal without scars. Wound healing is thought to decline with age. As the body ages, its inflammatory response decreases due to a weakening of the function of macrophages and T-lymphocytes, loss of reactivity and mobility of fibroblasts, a decrease in the number and other distribution of growth factors and their receptors, incl. TGF-β receptor. All this may explain the difference in the speed and quality of wound healing at different ages.

Although wounds in older adults heal more slowly, they have improved scar quality, which may be due to decreased levels of transforming growth factor (TGF-β) in damaged skin. It is also possible that fibroblasts of the fetal subtype appear in the wounds of elderly people, which leads to wound healing as in the fetus. Decreased levels of hormones, particularly estrogen, during menopause can also contribute to slower wound healing and reduced scarring.

Estrogens. In vitro studies have shown that sex hormones influence important stages of wound healing such as inflammation and proliferation. Estrogens regulate the production of TGF-β isoforms and the formation of their receptors, which plays a significant role in the development of fibrosis and scar formation. In healthy postmenopausal women, wound healing is slower but scar quality is improved, which is associated with decreased levels of TGF-β1 in wounds.

Against the background of hormone replacement therapy, wounds begin to heal faster, which suggests direct or indirect regulation of healing by sex hormones. Studies have shown that in menopausal women, hormone replacement therapy for 3 months. accelerates epithelization and collagen deposition in wounds.

The presence of estrogen receptors on the surface of fibroblasts indicates the possibility of direct regulation of the function of these cells by estrogens. In addition, estrogens increase TFP-β1 levels in vitro.

These data suggest the involvement of estrogens in the regulation of skin fibroblast production and TGF-β1. Finally, systemic administration of estrogen antagonists has been noted to inhibit wound healing in humans. A preliminary study of scars in women who received wounds while receiving the estrogen antagonist tamoxifen found that these scars were of better quality than scars left after the same wounds healed in women who were not given tamoxifen.

Heredity. There is evidence of the existence of a hereditary factor that affects the wound healing process, activating abnormal (pathological) scarring, which leads to the appearance of hypertrophic and keloid scars. Both autosomal dominant and autosomal recessive patterns of inheritance of keloid scars have been reported. Often, keloid scars are also observed in relatives of the patient with similar scars. In addition, the prevalence of keloid scars is significantly higher among dark-skinned populations, reaching 4.5–16% in Africans and Hispanics. The frequency of keloid scars is high in carriers of HLA-β14 and HLA-BW16, in people with blood type A (II) and those suffering from Rubinstein-Taybi syndrome.

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Clinical course and morphology of wound healing

Wound healing is a deterministic biological process that lasts about a year and ends with the formation of a mature scar. However, subsequently, the tissues that form the scar continue to change, although to a minimal extent.

From a practical point of view, in this biological process we can conditionally distinguish several periods, during which two main indicators, the most significant for both the surgeon and the patient, change significantly:
1) strength and external characteristics of the skin scar;
2) the possibility of lengthening and restructuring deep scars under the influence of tissue movement (movement of muscles, tendons, etc.).

Table 12.1.1. Clinical and morphological characteristics of the stages of uncomplicated healing of a sutured surgical wound

Stage 1 - postoperative inflammation and epithelization of the wound (7-10 days). During this period, processes of postoperative (post-traumatic) inflammation occur in the wound, after the resolution of which the swelling decreases and under certain conditions (uncomplicated course and comparison of the skin edges) epithelization of the skin wound occurs.

A distinctive feature of this stage of the wound process is the fact that the edges of the wound are connected to each other by very fragile granulation tissue, and not by a scar. Therefore, after removing the sutures on the 7-10th day, the edges of the wound can easily separate under the influence of even a small load. To obtain a minimal skin scar in the future, the edges of the wound must be held in place with sutures for a much longer period of time.

It is also very important that during this stage the sliding structures involved in the healing process of the wound (tendons, muscles, ligaments) remain mobile, however, their uncontrolled movements can intensify the process of postoperative inflammation and thereby worsen the quality of future deep scars.

Stage 2 - active fibrillogenesis and the formation of a fragile scar (10 - 30 days after surgery). During this period, active formation of collagen and elastic fibers begins in the young granulation tissue located between the edges of the wound, the number of which rapidly increases. This tissue quickly matures, which is accompanied by a decrease in the number of vessels and cellular elements, on the one hand, and an increase in the number of fibers, on the other. After this stage is completed, the edges of the wound are connected by a scar, which still remains extensible and noticeable to others.

During this period, deep scars are still capable of maximum restructuring when moving sliding structures involved in reparative processes. Therefore, it was at this time that surgeons begin to use special techniques aimed at restoring the mobility of tendons, muscles and joints. From this point of view, this period is key in restoring the function of tendons that have a significant amplitude of movement and are located in canals with dense walls (flexor and extensor tendons of the fingers in the corresponding zones, capsule and ligaments of joints).

Finally, this phase is different in that the tissues involved in the reparative processes still remain sensitive to any additional injury, including that caused by uncontrolled movements.

Stage 3 - formation of a durable scar (30-90 days). This stage lasts for the 2nd and 3rd months after the injury (surgery). During this period, the number of fibrous structures in the rumen increases significantly, and their bundles acquire a certain orientation in accordance with the dominant direction of load on the rumen. Accordingly, the number of cellular elements and vessels in the scar tissue decreases significantly, which is manifested by an important clinical trend - the transformation of a bright and noticeable scar into a less bright and less noticeable one. It should be noted that under unfavorable initial conditions, it is at this stage that the hypertrophic growth of scar tissue begins.

At the 3rd stage, internal scars also become significantly stronger, which gradually lose their ability to restructure and lengthen. Note that the formation of deep scars in conditions of complete 3-month immobilization of the limbs often does not leave patients any chance of restoring the function of the stitched tendons, especially if they have a significant amplitude of movement and are surrounded by dense tissues (for example, finger flexor tendons). The joint capsule also loses its extensibility, especially after damage to its elements and the surrounding ligamentous apparatus. In these conditions, effective rehabilitation involves appropriate surgical procedures.

On the other hand, upon completion of stage 3, almost full weight bearing on the sutured tendons and ligaments may be allowed.

It is important that at the 3rd stage of wound healing, the intensity of the processes of reparative tissue regeneration changes significantly: from relatively high to very low. We also note that during this stage, tensile forces exert a significant influence on the characteristics of the resulting scar. Thus, with longitudinal tightening of the scar, additional formation of collagen and elastic fibers occurs in the zone of this constantly acting force, and to a greater extent, the stronger the stretching. If in patients the processes of fibrillogenesis are initially enhanced, then the result of early exposure to the scar in the phase of active fibrillogenesis is the formation of hypertrophic and even keloid scars.

Stage 4 - final transformation of the scar (4-12th month). This stage is characterized by further and slower maturation of scar tissue with the almost complete disappearance of small blood vessels from it with further systematization of fibrous structures in accordance with the forces acting on this zone.

The result of a decrease in the number of vessels is a gradual change in the color of the scar: from bright pink to pale and less noticeable. Under unfavorable conditions, the formation of hypertrophic and keloid scars is completed, which sometimes significantly limit tissue function and worsen the patient’s appearance. It is important to note that in most cases, it is in the middle of the 4th stage that skin scars can be finally assessed and the possibility of their correction can be determined. During this period, the formation of internal scars also ends, and they are only slightly affected by the load.

Types of wounds and types of their healing. Main types of wounds

A wound is a violation of the anatomical integrity of tissues, accompanied by the formation of a wound space (cavity) or wound surface. Several main types of wounds can be distinguished: traumatic, surgical, trophic, thermal, etc. (Diagram 12.2.1).

Scheme 12.2.1. Main types of wounds and options for their healing.

Traumatic wounds make up the bulk of wounds and can be of a very different nature (from cuts to gunshots). These wounds can heal on their own or after surgical treatment, when the wound is transferred from traumatic to surgical.

Surgical wounds are distinguished by the fact that in the vast majority of cases they are inflicted with a sharp scalpel. This determines their cut nature and more favorable conditions for healing. A special type of surgical wounds are traumatic wounds treated by a surgeon. Their scale, location and condition of the walls of the wound cavity are often determined not so much by the surgeon as by the nature of the primary damage.

Trophic wounds occur when venous outflow and/or arterial inflow are disrupted, as well as from certain endocrine and other disorders. Their main feature is their gradual occurrence as a result of the slow death of tissues due to disruption of their nutrition.

Thermal injuries (burns and frostbite) have specific features, since the wound surface can be formed simultaneously (flame burn) or gradually (with frostbite), in the process of forming a line of demarcation and rejection of dead tissue.

Other wounds. Sometimes rarer types of wounds occur. These include wounds formed after self-opening of ulcers, deep abrasions, scratching, etc.

Types of wound healing

Traumatic and surgical wounds are of greatest importance for clinical practice. Their healing occurs in two fundamentally different ways: primary intention (primary healing) and secondary intention (secondary healing).

Wound healing by primary intention occurs in cases where the edges of the wound are no more than 5 mm apart from each other. Then, due to swelling and contraction of the fibrin clot, gluing of the wound edges may occur. Most often, this situation occurs when the edges of the wound are brought together with surgical sutures.

The second most important condition for primary wound healing is the absence of suppuration. This occurs if the edges of the wound are sufficiently close and viable, the intrawound hematoma is small, and bacterial contamination of the wound surface is insignificant.

Primary wound healing has three practical implications.

Firstly, it occurs in the shortest possible time, which, as a rule, means a minimum period of inpatient treatment for the patient, his faster rehabilitation and return to work.

Secondly, the absence of suppuration during reconstructive operations creates favorable conditions in the wound for the subsequent functioning of the structures restored by surgeons (in the area of ​​the tendon suture, the suture of blood vessels and nerves, the zone of osteosynthesis, etc.).

Thirdly, during primary healing, as a rule, a skin scar with more favorable characteristics is formed: it is much thinner and less often requires correction.

Wound healing by secondary intention is characterized by a much slower course of the wound process, when gluing of the edges of the wound cannot occur due to its large size. The most important features of this type of healing are suppuration of the wound and its subsequent cleansing, which ultimately leads to gradual epithelization of the wound in the direction from the periphery to the center. Note that peripheral epithelization is quickly depleted and can lead to spontaneous healing of the wound only if the size of the wound is not too large (up to 2 cm in diameter). In other cases, the wound granulates for a long time and becomes non-healing.

Wound healing by secondary intention is unfavorable in all respects.

Firstly, this process lasts several weeks and even months. Treatment of the patient requires not only constant dressings, but also additional operations (secondary sutures, skin grafting, etc.). This increases the length of the patient's hospital stay and economic costs.

Secondly, when the wound suppurates, the outcomes of reconstructive operations (including those performed for open injuries) sharply worsen. Thus, suppuration of the wound when a tendon suture is applied, at best, leads to blockage of the tendon with more pronounced scars, and at worst, to tendon necrosis.

The development of rough scars can block the regeneration of axons in the area of ​​suture or nerve repair, and suppuration in the area of ​​osteosynthesis usually ends in osteomyelitis. This creates new, often very complex problems for the patient, the surgical solution of which may require several months and sometimes years, and the effectiveness of the measures taken is often low. Finally, after the wound suppurates, as a rule, a wide scar is formed with a gross disruption of the surface of the skin. There are often cases when wound suppuration leads to disability and even creates a real threat to the patient’s life.

IN AND. Arkhangelsky, V.F. Kirillov